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Chain-of Custody Number <br /> SECOR Cham-of Custody Record <br /> Additional documents are attached, and are a part of this (record , <br /> Field Ofte XaCo <br /> a A t I L PIKS ��a� Sir, <br /> 34a Job Name _ - --- <br /> Address -- Location "+`40 W � � why F <br /> 5-+ Y ►n C/37- <br /> -c 1 <br /> Analysts Request <br /> Protect # N'Lb}'oob-O Task k `4 _ <br /> F <br /> Protect I+�artager <br /> c <br /> m 3 i <br /> I Laboratory V O C d <br /> Turnaround Time—SzWed <br /> v Qa d j O m <br /> 1:3 So CL <br /> L y ly r <br /> Samplers Name �-` u� 07 c� <br /> Sampler's Signature E m"` V t <br /> O x 2 o a v Q- it N -N 4 a Cammentsl z' <br /> U <br /> 8.0 a.o a. 3 w R o °'N d C] �'r U lnstrucllonl <br /> i Sam le ID Date Time Matrix z ►- �- d 2 r 1`1 <br /> d r <br /> I <br /> o <br /> I - <br /> -- t <br /> I <br /> — I <br /> r <br /> - — r <br /> I <br /> r <br /> Special InslruchonsJComr+ients Relinquished b _5JzrA Receive 1= _ Sample Receipt <br /> Sign Sign Total no of containers <br /> Prtnt C t Print _ Chain of custody seats <br /> Comp ny . Company___P _ _� Recd in good condition/cold <br /> Time , Z0 Date 3-�P-q 7_ Time Date {o _ Conlorms to record <br /> Relinquished by Rceived by r__ - Client S�[a.� <br /> Sign _ Srgn — <br /> Print Print Client Contact lb" '?,ro I <br /> - c <br /> Company Company r <br /> T hire _— Date Time _ Date Client Phone �� t g�4d c <br /> n c <br /> Date I _7 Page_ of _� <br />